Speaker 0: Welcome everyone to the Becker's Healthcare podcast series. I'm Mariah Muhammad, writer and moderator with Becker's Healthcare. And I'm thrilled to have with me today Caleb Ashmore, orthopedic rehabilitation services supervisor at Harris Health. Caleb, welcome to the podcast. We're very excited to have you join us today.

To get us started, would you mind please introducing yourself and telling us a bit about your background?

Speaker 1: Sure. Thank you very much for having me back. I really appreciate it. Yeah. My name is Caleb Ashmore.

I'm a physical therapist by training, ortho specialist, and a, manual therapy fellow, and I was both residency and fellowship trained here in Houston. Currently working toward an EMBA with an emphasis on health care leadership through UT Dallas. I'll be done with that next year, so I've been learning a ton. And it's a really cool, program. It's a cohort style, with leaders from Harris Health and then our two local med schools, Baylor College of Medicine and UT Health as well.

And I've been a supervisor in the, orthopedic rehab department for four years, And this is the largest outpatient center that we have at Harris Health that's here in, Bel Air, Texas. Not Bel Air, California. Bel Air, Texas. It is a it is a small pocket, community within Houston. And just a little bit about Harris Health is that we are a a teaching hospital.

About half of the physicians in Harris County were trained at Harris Health. And there was a recent study that showed for every dollar of tax support that we get for the community, we return, six. And so for every $1, we return six in economic benefit. And last year, we had 5,000,000,000 returned to Harris County and almost 6,000,000,000 in in economic impact to the state of Texas, which is was pretty cool and something to be proud of. And, currently, one in 70 jobs within Harris County are at Harris Health.

So we're, a very big employer. We have about 11 almost 11,000 employees at this time. And the reason, that that we are so important and why I love working here is that the mission and that we have, 1,200,000 uninsured people in Houston currently, which is the most uninsured individuals in our country. And so that stands to probably increase after the the recent legislation, over the next couple of years with the Medicaid cuts. And but currently, our payer mix is about, 50% uninsured, 20% Medicaid, 20% Medicare, and then about 12% private insurance.

And then, finally, we have about 300 almost 300,000 individual patients that we're currently treating at Harris Health.

Speaker 0: Wonderful. Wonderful. Well, thank you so much for that background information. To jump into the questions, what are some of the most exciting or impactful changes you've seen recently in the orthopedic rehabilitation, area, whether it's new research, tools, or treatment approaches.

Speaker 1: Yeah. Over my, twelve plus years of being a physical therapist, a lot of things have changed. Lately, over the past couple of years, there's been sort of a a move away from manual therapy approach and other other, types of passive treatments, like modalities, dry needling, and things like that. Things that really haven't, shown as much support in the literature as they've been studied year after year. And then, basically, increasing evidence based practice by leaning into more, treatments that are that are more active, like exercise, different tissue loading tactics, things with more of a solid, support in the in the in the, research that's out there.

Also, patient education is a huge one for for our profession. Also, as as all other areas of health care, telehealth has been huge after after the pandemic. And so, you know, whereas before the pandemic, hardly any PTs were utilizing telehealth. We're using it a ton. I know not every organization is just due to constraints with reimbursement and things like that.

But since our health care system doesn't really have to worry about that as much, We, you know, there's a pretty big push in our system to to utilize this because we have you know, Houston is so spread out. It's it covers so much territory, so many miles that we're able to reach, many more patients who have difficulty, utilizing our services for a variety of factors, like their work schedules, mobility limitations, their financial constraints, and also, issues that they have with with transportation. And so through the, this expansion of telehealth services, it's been it's been really, really really amazing. We've been able to enroll more people and and have better, patient accessibility or, for people who might not otherwise be able to finish out a a plan of care, for example. And helps not only with our our Ortho rehab team, but also with, a class that we have called FAST, which stands for, fit and strong together.

And it's a twelve week course that we have that's led by physical therapists and dietitians, and it's twice a week. Before COVID, they were all in person. And so, you know, patients had to commit to coming into our clinic twice a week, which is pretty tough for a lot of folks. But now with telehealth, we're able to expand the class and and reach a lot more people and impact a lot more lives. So, you know, that's been pretty pretty exciting.

A few other things too. Like, we have some some novel research that we have going on right now with, a couple of our orthopedic. So another thing I I failed to mention is that, Benta, we currently have, is one of our hospitals. We currently have one level one trauma center, and we're currently in the process of building a, second level one trauma capable hospital, at LBJ. And so we get a lot of trauma cases, which is kinda different than a lot of other PT settings.

And so we have a surgeon who specializes in, treating these patients with an external fixator when they've had really, traumatic comminuted fractures. And, so and then we he loves PT, and we have a really good relationship with him. So with our our, current and future, PT residents, we have research going on with him and then also with another, one of the surgeons who is working on a new procedure. He's been he's been, testing it out. And this this is a procedure for fixing calcaneal fractures, which we actually see a lot in our system.

And it's a novel approach and something that hasn't been, tried before. And so in both of these areas, there's very little research, little to no research. And so, yeah, we're really looking forward to to being able to, put our our footprint, so to speak, and and to to just put some stuff out there for people who for other people who do treat these patients as well.

Speaker 0: Yeah. Yeah. Absolutely. No. That definitely sounds so amazing.

And how do you approach rehab for patients with complex orthopedic conditions? We'll also have social economic barriers to care, which I know you spoke a little bit about, and I'm assuming that Harris Health likely sees this pretty often.

Speaker 1: Yes. We do. It it impacts you on a regular basis, and and really, it's something that you have to think about with each patient, you know, getting into social determinants of health, which are, you know, non health care related factors that affect a person's health and well-being. And so, you know, there was, there's been several studies that have come out, that I learned about in my EMBA program where but, essentially, they look at at people and how much health care can actually affect a person's life. And, actually, what, multiple studies have found is that even at even at our best as health care workers, we can only affect about 20% of a person's life.

The rest of the 80% of that person's life are affected by, social determinants of health. And so it's something that not a lot of folks think about unless you work in a system like this. And, you know, I mean, you probably do think about it in other in other systems, but not on a regular basis like we do, you know, almost every day and all day. We have a population health team, which works, you know, directly with patients out in the community. We're the currently, the only hospital system in Houston that has a, a hospital at home program where they have, patients that are would normally be in a hospital.

But in order to keep them out of our hospitals and actually treat them more effectively and reduce risk of getting a a nosocomial infection, they'll be treated within the, the confines of their own home, which is really nice. And so people, nurses, and other health care providers go out to the person's home. And, and that's been really successful so far. And what they're looking to expand that program and actually include, rehab. So that's pretty exciting.

And I was actually, talking with them today about potentially in including us in that in that process. So it's pretty pretty exciting. Lots of changes coming. We have currently, I believe, 37 clinics throughout Houston, outside of our our large hospitals. And so we really try to to put these clinics out in areas where the patients need them, and so that it's more convenient for them.

You know, a lot of our a lot of our folks take buses and have different transportation issues if they get rides and, you know, don't have their own vehicles and things like that. And so, or or maybe their vehicle is not as reliable. And so we we really just try to to meet these patients where they are and where they need us to be. As I mentioned, telehealth has really helped with that. We have we have a lot of patients without stable housing and and, you know, they might be living in shelters, and so that presents difficulties.

And there's lots of, pain management that goes on at these clinics. We have a, several, actually, food pharmacies for patients, with diabetes. And it's really cool. They can get referred directly to these pharmacies, and they have high quality, healthy food for, patients who would otherwise not be able to afford it. And this is food, donated from Houston Food Bank.

And so there's there's a lot of really cool partnerships we have with organizations throughout Houston to help care for these these patients. And so sometimes patients come in, and you don't end up doing a lot of traditional therapy. Yesterday, I was having a patient. I was helping him, fill out paperwork to get a handicap placard because he really does need it. His hip he has, like, really bad, hip arthritis.

And so I was like, you know what? Actually, I do think you need this. And so I was helping him with that. And so you just never know on a given day what your job's gonna look like, but it's never boring. It is never boring.

And on that note, we actually have a Harris Health is now the official medical provider for, the corrections facilities at Harris County. So we're also seeing, you know, a fair amount of incarcerated patients as well. And so just trying to provide the best care possible for every single person on your schedule. Some days, you gotta get creative. If you're doing a telehealth call with somebody and they don't have weights, I'll say, okay.

Can you grab some water jugs, or what do you have handy? One thing that was really cool is that, many years ago, a patient a student of ours, as his his internship project, he came up with a list of all of the local discounted and free gyms throughout Houston. And then, last year, somebody digitized it. The the Gen z, students are really pretty incredible when it comes to technology. They digitized it, attached it to Google Maps, and so all the person has to do is scan this QR code, and it will find all of the local free and discounted gems that are close to the person's house.

And so that really helps us to have a better long term carryover effect for maybe, for folks that don't have access to a gym and and might not be able to afford it. And, the the fast class that I mentioned before really really works on, our CEO, doctor Porras, his overarching goal of disease prevention and health promotion. Because if we're able to, affect change on on on these levels and maybe dip into that 80% a little bit, then we can, you know, keep people out of the emergency department and and save our system and, taxpayers a lot of money.

Speaker 0: Yeah. Yeah. Absolutely. That definitely makes a lot of sense, and I definitely see a lot of, opportunities for growth and a lot of things that you said. For you, what's one leadership lesson you've learned while working within a safety net like Harris Health that's kinda shaped you, to how to show up for your team and your patients?

Speaker 1: There are so many. I had to I wrote a bunch down, and I had to delete a bunch because I wouldn't have time to get to it all, but I'll just I'll hit the highlights. I think for me, grace for not just for your patients, but also those that you work with and also for yourself. Basically, the the saying that I like from the office is called that they say is that po buddies are perfect, which is a funny way of saying nobody's perfect. But, you know, don't stress out.

Don't don't feel like you have to be living up to, you know, insane expectations. Make sure you have realistic expectations. You know, just assume positive intent. If somebody is rubbing you the wrong way or you think you feel like maybe a person has it out for you or or is trying to make your life miserable, just consider that they they're most likely doing the best they can that day, and you don't really know what's going on in their lives. As I mentioned previously, when it comes to our patients, but also the people you work with, you really don't know what all is going on in their lives.

So give people grace. People are complex. We're all going through our our own trials and tribulations. And so, you know, afford other people the grace that you would hope that they would afford you. And just remember that everybody that you work with, no matter what level, be it EBS or frontline all the way up to c suite, everybody is important.

And we can only succeed if we all succeed. So just try to take care of each other. Just try to be good to other people in general. That's something that we that we say in my family a lot is when one of us succeeds with with our kids, we've been hammering this. When one of us succeeds, we all succeed.

That way, I have two little girls. I have a a three year old and a five year old, and they can get kinda competitive with each other. And so we'll say to each other, hey. Just because for example, the other day, we were playing a board game randomly. My three year old daughter ended up winning the board game.

And so my five year old's getting upset because she's, you know, losing. And so we just have to say, like, when one of us is winning, we're all winning. Be happy for each other. Applaud other people's successes. Comparison is the thief of joy.

That's another thing that I like to say a lot is just try not to compare yourself to others. I know our society is very into that with social media, but just just kind of stay in your own lane and and keep plugging along. Try to get 1% better and grow every day as a person, as a as a professional, as a health care worker. And, yeah, you'll be on the right track.

Speaker 0: Yeah. Yeah. Absolutely. Great words of, wisdom there. Thank you so much for those final thoughts.

It's definitely been a very informative discussion. So I wanna thank you so much for coming back on Becker's Healthcare. We really do appreciate it, and I look forward to connecting with you again soon.

Speaker 1: Thank you very much. I really appreciate it. Have a good one.